Individual provider Active NPI

Ryan Moylan, MS

  • Mental Health Counselor
  • Braintree, MA
National Provider Identifier
1811405632
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
12757 Issued in MA
Practice address
140 Wood Rd Ste 206
Braintree, MA 02184-2508
Phone
(978) 222-3121
NPI assigned
Jan 15, 2018
Last updated
Dec 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X 12757 MA Primary

Addresses

Primary practice location

140 Wood Rd Ste 206
Braintree, MA 02184-2508

Mailing address

32 Sassamon Ave
Milton, MA 02186-5816
Phone (781) 964-1820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231228000768 MA Practitioner - Mental Health Counselor 6800246232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

40 Shattuck Rd
Suite 250
Andover, MA 01810-2492
Phone (978) 222-3121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
12757MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care of Connecticut, P.C. CurrentSince Apr 20, 2024 Accepting new patients
Optum Behavioral Care of Connecticut, P.C. CurrentSince Apr 20, 2024 Accepting new patients

Locations

40 Shattuck Rd
Ste 250
Andover, MA 01810
Phone (401) 595-2982

140 Wood Rd
#206
Braintree, MA 02184

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1811405632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 SASSAMON AVE",
            "city": "MILTON",
            "state": "MA",
            "postal_code": "021865816",
            "telephone_number": "781-964-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 WOOD RD STE 206",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021842508",
            "telephone_number": "978-222-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYLAN",
        "first_name": "RYAN",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-15",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "12757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

Verify at the official NPI Registry.